Psychological triage in multi-affected incidents: a simulated video-based assessment study with emergency responders in Spanish-speaking countries

Abstract Background Psychological triage in large-scale emergencies involving relatives and close contacts of victims remains insufficiently standardised, despite growing recognition of their acute distress and anticipatory anxiety. The triage procedure used in this study was based on a three-level, color-coded system (red, yellow, green) reflecting increasing levels of psychological risk. Structured support materials may help responders classify individuals more consistently, yet empirical evaluations of such tools are scarce. Methods A quasi-experimental two-group design was employed. One group performed psychological triage using a structured Checklist, while the comparison group conducted triage without support material. Both groups evaluated the same set of simulated cases presented through standardised video-based scenarios. Prioritisation accuracy was defined relative to a reference standard established by an independent expert panel. A multilevel logistic regression model and complementary tests were used to analyse triage performance and assessor-related variables. Results The Checklist improved overall prioritisation accuracy and reduced systematic misclassification in mild and ambiguous cases. Its contribution was less pronounced in high-priority scenarios. Assessor-related variables—including Emotional Intelligence, psychology training, sex, and age—did not predict triage performance. Resilience showed a small inverse association with accuracy, which should be interpreted cautiously. Conclusions Structured support material can enhance the consistency of psychological triage in multi-affected incidents. The findings highlight the value of simple, evidence-informed tools to support rapid prioritisation in large-scale emergencies and underscore the need for continued refinement and validation of triage instruments. Given the preliminary nature of the Checklist and the limitations of the design, the results should be considered initial evidence rather than definitive validation.